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1 <br /> I <br /> ELECTRICAL PERMIT APPLICATION. <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> `PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: ;o I <br /> " f <br /> BUILDING AREA if residential,new Con$truction,remodel,or addition) S 31, <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> { USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ , r <br /> NUMBER OF DEVICES lif low voltage} <br /> FIRE ALARM? ''ES D NO <br /> `:SSOOJATED BUILDING PERMIT# if a.•icatxIe <br /> DESCRIPTION OF WORK: Aletti 160AMP <br /> U - A <br /> - <br /> CONTACT INFORMATION <br /> OWNER NAME:Pacific Rid! , <br /> . TENANT NAME If Commercial: <br /> OWNER•MAILING ADDRESS: STREET 21300 Victory BLVD STE 700 <br /> CITY Woodland Hills STATE CA <br /> OWNER PHONE: <br /> ZIP 91367 <br /> OWNER EMAIL: <br /> CONTRACTOR NAME: Provident Electric Inc <br /> CONTRACTOR ADDRESS: STREET PO Box 7087 <br /> ... - CITY Covington <br /> STATE WA ZIP 98042 <br /> CONTRACTOR PHONE:253-631-7750 x 1028 CONTRACTOR EMAIL: permits's t <br /> rovidentelectric.net <br /> CONTRACToft LIC.*REQUIRED, PROVIEI 103C2 <br /> CITY OF EVERETT BUSINESS LIC..#( cutasc):043329 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> CONTACT PHONE: 253-631-7750 x 1028 <br /> Shannon Chelette CONTACT EMAIL e- <br /> t`i IAS s •rOVidentelectric.net <br /> AGREEMENT:t hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type <br /> of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or <br /> local law regulating construction or the performance of construction. That 1 am authorized by the owner of this property to perform the work for which application is made and I <br /> comply with the State Contractors Law Y8,27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> -7 .1 E kT -C) <br /> Owner/Authorized Agent Signature <br /> "(Revised 9/23/2016) <br />